Provider Demographics
NPI:1134418627
Name:YOUNG, STEPHANIE ANGEL
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANGEL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4937
Mailing Address - Country:US
Mailing Address - Phone:304-529-6205
Mailing Address - Fax:304-529-6209
Practice Address - Street 1:2001 MCCOY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4937
Practice Address - Country:US
Practice Address - Phone:304-529-6205
Practice Address - Fax:304-529-6209
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist